OVER THE COUNTER: Compounding pharmacies tailor medications to individual needs

By Steve Bernardi and Gary Kracoff/Daily News Correspondents

Tuesday

Jan 24, 2017 at 8:08 AMJan 26, 2017 at 9:57 AM

For many people, pharmaceuticals are a one-size-fits-all product. Your doctor writes a prescription, you go to the drugstore, and you come home with an amber vial of pills to treat the illness or condition for which they are intended.

But what if your elderly parent or small child can’t tolerate pills? What if you are allergic to an ingredient in the pills? Or what if the pills you need are back-ordered or otherwise unavailable?

The solution to all three quandaries is a compounded medication.

Pharmacy compounding is a small but vital part of the big world of medical treatments and cures. Compounding pharmacies can alleviate the need for workarounds used for a person who cannot tolerate a medication in its manufactured form, such as cutting a tiny pill into even tinier pieces to get a smaller dosage or mixing a medicine with chocolate syrup so your child will swallow it.

Compounding allows prescriptions to be precisely tailored to an individual’s needs. Drugs that are normally in pill form can be turned into liquids, lozenges or creams. Dosages not manufactured by pharmaceutical companies can be made for children or others who need a particular strength that would be otherwise unavailable. And medications that have artificial dyes or binding agents or fillers that cause allergic reactions in some people can be specially made without those inactive ingredients.

The compounding pharmacy is a core component of individualized medicine. And, as in many other areas of health care, it’s rapidly changing. We’ve been involved in compounding pharmacies for more than 40 years, and they’re nearly unrecognizable from how they were in the old days — like when we were in college.

In the last several decades, the practice has gone from a relatively informal one in which a pharmacist calculated the ingredients of a medication by hand on scratch paper and then mixed them up for the patient, to one that’s heavily regulated (by the state and the FDA), uses highly specialized equipment to ensure proper dosages, purity and hygiene and that has layers of checks and record keeping to make sure procedures are properly followed.

Long ago, before the mass production wave that occurred during the middle of the last century, most medications were mixed and provided by the local pharmacist — often called “druggists” in those days. Compounding was routine.

Probably one of most dramatic changes to compounding in recent years, besides the regulations and safeguards, is the technology. It used to be that most of the work was conducted on a tile surface and in beakers — much like those you might remember from your high school chemistry laboratory. Now, professional compounding pharmacies invest in advanced equipment that mechanically mixes and measures ingredients for ointments, spins the components of a medicine, and filters the air in specialized rooms, under equipment called “hoods” to protect the integrity of drugs and the safety of technicians. Staff wear garb that resemble space suits and that ensure all body parts are 100 percent covered.

Compounding is also often used for veterinary medications, mainly for ease of administration. Anyone who has ever tried to open a pet’s mouth to force a dose, or plant a pill in Rover’s chow only to find the bowl licked clean but for the pill, can relate to the need for an easier way. Compounded creams can be placed in some instances under the flap of a dog’s ear without any resistance whatsoever.

Finding the right compounding pharmacy, just like choosing any service provider, can be difficult. We advise talking with the pharmacists to see how well they answer your questions. Can they tell you whether a hormone is synthetic or natural, or the origin of a drug? How long it will take for the medicine to be ready?

In general, if a specially made drug will be available quickly — like in a half hour — that should raise a red flag. If the pharmacists are making the medication just for you, and taking all necessary precautions and checks on purity, the turnaround time should not be so quick.

We also advise looking at the pharmacy itself. Does it look clean? Are there windows allowing you to see people at work compounding the medications, or is everything taking place in a back room? Also, you'll want to make sure the pharmacist cares for you as he or she would a family member. Spend some time talking with the staff, and see how professional and attentive they appear.

For a patient whose needs are met by off-the-shelf medications, most any licensed pharmacy will do. Convenient location and extended hours are the keys.

Patients struggling to find the right medication in the right dose and the right form can take comfort knowing that compounding pharmacies can be a solution to their problem.

Steve Bernardi is a compounding pharmacist and Dr. Gary Kracoff is a registered pharmacist and a naturopathic doctor at Johnson Compounding & Wellness in Waltham, Mass. For more information, visit naturalcompounder.com. Readers with questions about natural or homeopathic medicine, compounded medications, or health in general can email steveandgary@naturalcompounder.com or call 781-893-3870.

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